Perhaps the food with the most renown for its direct effects on the digestive tract – and subsequent health consequences – is gluten. Depending on who you choose to follow, gluten is either the stuff of the devil or completely benign – making gluten avoidance just another health fad.
I have seen a recent spate of posts and media criticising the avoidance of gluten. The suggestion is that proven Coeliac Disease is present in just 1% of the population – therefore those who are complaining of issues with gluten are either making it up, falling for some dietary hype or suffering from the Nocebo Effect (where you think something is going to create symptoms, so it does).
Having just come back from a short break to Italy (literally the land of gluten-based products such as pizza and pasta) I felt that I should write just a short overview on why I spent my Italian weekend away continuing to avoid gluten.
Individualising Dietary Advice
Any of my patients reading this will know that I am a very moderate practitioner when it comes to diet. I simply don’t believe that diet (and avoiding foods) is the miracle cure for all ills. In many cases, food is simply a tool to help change your health. Even in the worst of autoimmune cases I do not always prescribe mandatory Autoimmune Paleo diets – and when I do, I am very clear about the purpose of such diets: they are re-regulating a system and calming inflammation in the short term. Whilst using the diet we must also address the other, deeper reasons why inflammation and autoimmune aggravation is occurring. Rarely is that just about food.
So even when it comes to gluten I am not someone who has strict rules about the consumption of this protein. I do not believe, contrary to some professionals in my field, that every person needs to avoid gluten because it is causing damage to their gastrointestinal tract. This concept is simply not borne out by the literature.
The truth about food and gluten tolerance will always lie in a personalised approach. And whether we can digest and tolerate certain foodstuffs is actually directly linked to our overall level of health and resilience. Yes, this includes gluten.
So What Really Happens With Gluten?
Alessio Fasano has been instrumental in providing evidence to suggest that the gluten protein has a complicated binding effect on the gastrointestinal tract, promoting the release of a substance called zonulin which is responsible for the regulation of the tight junctions which govern what passes across the gut wall into the body. The gut is supposed to be selectively permeable – letting nutrients in but keeping toxins and larger particles out.
Too much zonulin = dysregulated tight junction control = too large molecules or too many molecules crossing into the bloodstream and hitting the immune tissue around the gut. This leads to localised and then systemic inflammatory reactions. And, apparently, it does this in everyone.
But that doesn’t actually mean that no-one should eat gluten. This is where your current level of health directly affects your ability to digest certain foods. If you are relatively healthy then you will be able to not only deal with the temporary heightened gut permeability created by gluten, but you will also have a body that is capable of regulating inflammatory status and bringing down any reactivity that might result from a slightly permeable gut.
Additionally, if gluten is consumed in the context of a healthy diet rich in antioxidants and polyphenols, there will be a large amount of anti-inflammatory molecules floating around to accompany the gluten.
Speaking of polyphenols, which have a direct effect on gut lining and the microbiome, there is evidence to suggest that changes in gut bacteria can modulate the immune reactivity to gluten in those with Coeliac Disease. This would suggest that there are other factors at play in the progression of both Coeliac Disease and gluten sensitivity – and it’s not all about the gut lining or the immune system in isolation but involves both the microbiome and the immune system and their relationship to one another.
I do think that those who are critical and sceptical aren’t really aware of these factors. Certainly, it might be that people’s reactivity to gluten is based upon their poor health in other areas, especially the microbiome. But in a world where antibiotics which affect the microbiome have been given out freely for decades, it is not too much of a stretch to imagine that many people have worn down their tolerance to the gluten protein.
My Patients & Gluten
Now, most patients who see me are those that I would recommend to avoid gluten. Why? Because all of my patients are actually quite unwell – many of them with gastrointestinal issues, microbiome dysbiosis, inflammatory and autoimmune conditions. In the context of a body that is suffering from one of these conditions adding in a protein that may further aggravate their conditions is unwise.
Pre-existing ill health – in any system, gut-based or otherwise – means that your body is already working very hard. Ill health is literally an indication that the body is struggling. Adding in a protein which creates extra work for your system, and extra inflammation, is not going to be a sensible idea. This means that during treatment with me I am almost always recommending a gluten free diet – at least for the duration of our work together.
But this is always presented in the correct context – and I am always at pains to explain that gluten doesn’t cause the issues (in almost all cases), it just prevents us from dealing with them. Avoidance of gluten may be short or long term, and that all depends on the nature of the illness and its progression.
In most cases, however, I’m working towards getting my patients into a state of health that is resilient enough to cope with gluten.
If gluten intolerance is not a pathology in itself, but based on the health of your immune system, inflammation status and microbiome, my job as a practitioner is to get my patients into a state of robustness which gives them a strong immune system, low inflammation and a rich microbiome.
Myself & Gluten
So in the context of all of this – why did I spend my time in Italy avoiding gluten (and dairy, for that matter). Surely my health should be robust enough to handle it?
Well, there are two issues here. Firstly, I have a connective tissue disorder which directly affects the strength and integrity of my gut lining. This means that already my gut isn’t the strongest in the world – so adding in a protein that will further compromise its integrity is unwise.
I am therefore one of those people whose health is simply too easily undermined by gluten. And I do notice it immediately if I have it – my fingers become puffy, my lymph glands in my neck swell slightly and I can get spots.
Secondly, I have been managing some quite precarious health recently. I plan to write about this in a blog which will come out in the coming weeks – but I haven’t been vibrantly healthy or robust at all. There have been very specific reasons for this, and the circumstances only changed the day before I left for my holiday. This meant that I was reluctant to experiment or try anything to tip the delicate balance of my health whilst I was away.
Will I ever get to a point of consuming gluten without consequence? I honestly don’t know. But that’s my unique body with its own genetics and chequered history of health experiences. It’s not at all because I think gluten is in any way terrible for everyone.
Instead, I recognise that gluten is perhaps one of the more challenging foodstuffs for the human body to contend with. This means that in times when health is compromised or reserves are low, eliminating this stress on the body is – probably for most people – a pretty sensible choice.
Stay tuned for more on my health – and for an article about what to do for your digestive health if you’ve tried EVERYTHING dietary and still you don’t feel right.